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For people who own cars, it's fairly easy to get to a doctor, a grocery store that offers fresh fruits and vegetables, or a park where they can exercise. But in many low-income communities of color, where residents depend on public transit and walking, poorly planned development and inadequate transit funding have put many of these basic services out of reach.

As residents of these communities know - and research has confirmed - inadequate transportation is one of the primary reasons that low-income families miss, or forego scheduling, medical appointments. The problem is particularly acute with chronic and preventative care, and when children have to be transported as well.

The myriad health problems of low-income people of color make these transportation barriers nothing less than urgent. According to the U.S. Department of Health and Human Services, there is "compelling evidence that race and ethnicity correlate with persistent, and often increasing, health disparities among U.S. populations."

The situation is becoming even worse as the frenzied pace of health care "consolidation" continues. Mergers are spawning the closure of facilities in areas that need it most, such as the planned closure of the San Jose Medical Center, in downtown in San Jose, or forcing cutbacks in services such as those anticipated from the proposed Summit/Alta Bates merger in Oakland.

Ignoring this serious and far-reaching situation, elected leaders are instead focusing new transportation investments on "congestion relief" that primarily benefits long-distance white-collar commuters, leaving the needs of low-income communities of color unmet. Our collective failure to bring critical analysis and new voices to demand transportation justice is hurting our communities while promoting an unhealthy and unsustainable dependence on automobiles.

Transportation for Healthy Communities Collaborative

Roadblocks to Health is the product of a remarkable collaboration between social justice community organizers and transportation advocates - a two-year project dedicated to making the health of low-income communities of color a top transportation priority. This project has been led by the Transportation and Land Use Coalition (TALC), Center for Third World Organizing (CTWO), and People United for a Better Oakland (PUEBLO).

Roadblocks to Health examines the transportation barriers to health care, nutritious food, and physical activity for residents of fifteen low-income communities in Alameda, Contra Costa, and Santa Clara Counties. TALC conducted a Geographic Information Systems (GIS) mapping analysis to identify the number of people in each neighborhood who have transit or pedestrian access to health care facilities and supermarkets. This represents the most detailed analysis of access to health care in the Bay Area, and the methodology represents an advance in the state-of-the-art for transit accessibility analyses. PUEBLO spearheaded a community survey of 699 residents in four languages, and CTWO provided critical racial justice analysis and overall project coordination.

Findings

The mapping, survey, and research findings presented in this report clearly demonstrate that the Bay Area's most disadvantaged communities face significant transportation barriers to healthy activities. In low-income communities of color, where car-ownership rates are low, inadequate public transit limits access to hospitals, community clinics, supermarkets, and regional parks. People of color are disproportionately injured and killed on unsafe streets - a health crisis in itself that in turn contributes to fears of walking and bicycling.

Access in each of these communities varies significantly, but none is adequately served. Some of the key findings include:

Alameda County

Only 28% of the residents of Alameda County's disadvantaged neighborhoods have transit access to a hospital, leaving over 160,000 residents without transit access.

African-American pedestrians in Alameda County are 2.5 times more likely than white pedestrians to be hit by a car and killed or hospitalized.

Contra Costa County

Contra Costa County's disadvantaged neighborhoods have the worst access of the three counties in this study: 20% of residents have transit access to a hospital, 33% have transit access to a community clinic, and 39% have walking access to a supermarket.

In four of the county's six neighborhoods, no residents have transit access to a hospital.

In Monument Corridor neighborhood in Concord, residents suffer from 0% transit access to hospitals and only 1% access to clinics, despite the presence of facilities nearby.

North Richmond residents have 0% access to hospitals and supermarkets.

Santa Clara County

Of the three counties studied, Santa Clara County's disadvantaged neighborhoods residents have the best transit access to hospitals and supermarkets.

Access to hospitals is threatened by the planned closure of the San Jose Medical Center, which would reduce transit access to a hospital from 42% to 0% for residents of downtown San Jose, and from 74% to 48% for residents of East San Jose.

Residents of suburban Gilroy suffer from poor transit access under all the measures in this report, including 0% access to clinics, 7% transit access to hospitals and 33% to supermarkets.

Recommendations

The findings of this report are disturbing, but there are investment and policy solutions that can tear down these barriers. Over the next three years there will be up to $16 billion in new transportation funding proposals in the Bay Area, providing a once-in-a-generation opportunity to fund these solutions. This report offers us a new way of looking at transportation as a vital public health resource, and opens the doors to new forms of collaboration and coalition building. Some of the to priority recommendations include:

Meet basic transit needs of low-income communities of color.
First and foremost, we must begin by insuring that low-income communities of color have their basic transit needs met. The Metropolitan Transportation Commission recently identified a Lifeline Transit Network that would help meet many of the basic needs of low-income communities. This should be the top priority for funding, complemented by free transit passes for low-income families.

Make health access a top priority in transportation policy and planning.
Leaders from the transportation and health care communities need innovative collaborations that elevate health access issues on the transportation agenda. Some policy initiatives include identifying community clinics - not just hospitals - in the Lifeline Transit Network and requiring transit agencies to conduct a "Health Access Impact Analysis" of proposed route cuts and expansions. To promote healthful activity, funding for pedestrian and bicycle safety projects and for transit service to regional parks should be significantly increased.

Make Medi-Cal transportation assistance available to all recipients.
California should follow the example set in other states by expanding Non-Emergency Medical Transportation (NEMT) eligibility to include all people without access to a car - not just people with physical disabilities - and allow funds to be used for public transit.

Direct public resources towards disadvantaged neighborhoods, without displacing existing residents.
We must reward cities that invest in transit-accessible services and facilities and expand programs, such as MTC's Housing Incentive Program, that support transit-oriented affordable housing in these communities.

Guard against reductions in transportation access to health care.
Access depends on location. With a growing population, the health care industry should be opening new facilities, not closing or significantly reducing service at existing facilities that serve disadvantaged communities. We need to make public transit access a key consideration in any decision to close or significantly reduce service at a health care facility. Similarly, we must plan for high levels of transit access when considering the location of new facilities.

Support innovative efforts to ensure food security in these neighborhoods.
Increasing access to healthy food must rely on a combination of efforts, including providing shopper shuttles to supermarkets, helping corner stores improve their food quality and operation, and reinvesting in inner-city supermarkets.